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Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs

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Abstract

Unhealthy substance use in the USA results in significant mortality and morbidity. This study measured the effectiveness of paraprofessional-administered substance use screening, brief intervention, and referral to treatment (SBIRT) services on subsequent healthcare utilization and costs. The pre-post with comparison group study design used a population-based sample of Medicaid patients 18–64 years receiving healthcare services from 33 clinics in Wisconsin. Substance use screens were completed by 7367 Medicaid beneficiaries, who were compared to 6751 randomly selected treatment-as-usual Medicaid patients. Compared to unscreened patients, those screened changed their utilization over the 24-month follow-up period by 0.143 outpatient days per member per month (PMPM) (p < 0.001), −0.036 inpatient days PMPM (p < 0.05), −0.001 inpatient admissions PMPM (non-significant), and −0.004 emergency department days PMPM (non-significant). The best estimate of net annual savings is $391 per Medicaid adult beneficiary (2014 dollars). SBIRT was associated with significantly greater outpatient visits and significant reductions in inpatient days among working-age Medicaid beneficiaries in Wisconsin.

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Abbreviations

ACA:

Affordable Care Act

ASSIST:

Alcohol, Smoking, and Substance Involvement Screening Test

ATE:

Average Treatment Effect

DiD:

Difference-in-differences

MA:

Medicaid

PMPM:

Per member per month

PSM:

Propensity Score Matching

SAMHSA:

Substance Abuse and Mental Health Services Administration

SBIRT:

Screening, brief intervention, and referral to treatment

USPSTF:

United States Prevention Services Task Force

WIPHL:

Wisconsin Initiative to Promote Healthy Lifestyles

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Acknowledgments

The research team would like to thank the Wisconsin Department of Health Services Bureau of Prevention Treatment and Recovery Program Director, Joyce Allen, for her support in administering the SAMHSA grant. We also thank Dr. Daphne Duo, assistant scientist at the University of Wisconsin Population Health Institute, for her expertise and assistance in cleaning the datasets and constructing the analysis files.

Authors’ Contributions

Dr. Paltzer led the study, constructed the data set, conducted the analyses, and is responsible for the integrity of the data and the analysis. Dr. Brown and Dr. Moberg initiated the study concept and preliminary design, and all authors contributed to the ongoing development of the study. Dr. Paltzer, supported by Dr. Mullahy and Dr. Weimer, contributed in the analysis and interpretation. Dr. Paltzer drafted the manuscript. Dr. Paltzer, Dr. Brown, Dr. Mullahy, Dr. Moberg, Dr. Burns, and Dr. Weimer revised the manuscript.

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Authors and Affiliations

  1. Population Health Institute, Population Health Sciences Department, University of Wisconsin-Madison, 6622 S. 50th Ave, Phoenix, AZ, 85339, USA

    Jason Paltzer PhD, MPH

  2. Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm. 787, WARF Building, Madison, WI, 53726, USA

    Richard L. Brown MD, MPH

  3. Department of Family Medicine, University of Wisconsin-Madison, 1100 Delaplaine Court, Madison, WI, 53704, USA

    Marguerite Burns PhD

  4. Population Health Institute, Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street 575-E WARF, Madison, WI, 53726, USA

    D. Paul Moberg PhD

  5. Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm 601, WARF Building, Madison, WI, 53726, USA

    John Mullahy PhD

  6. Population Health Sciences Department, University of Wisconsin-Madison, 610 Walnut Street Rm 501 WARF Building, Madison, WI, 53726, USA

    Ajay K. Sethi PhD, MS

  7. LaFollette School of Public Affairs, University of Wisconsin-Madison, 1225 Observatory Drive, Madison, WI, 53706, USA

    David Weimer PhD

Authors
  1. Jason Paltzer PhD, MPH
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  2. Richard L. Brown MD, MPH
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  3. Marguerite Burns PhD
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  4. D. Paul Moberg PhD
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  5. John Mullahy PhD
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  6. Ajay K. Sethi PhD, MS
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  7. David Weimer PhD
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Corresponding author

Correspondence to Jason Paltzer PhD, MPH.

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Conflict of Interest

Dr. Brown is CEO of Wellsys, a company helping healthcare settings deliver behavioral screening and intervention (BSI) services.

Funding and Support

SAMHSA Grant #5U79T1018309.

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Paltzer, J., Brown, R.L., Burns, M. et al. Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs. J Behav Health Serv Res 44, 102–112 (2017). https://doi.org/10.1007/s11414-016-9510-2

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  • DOI: https://doi.org/10.1007/s11414-016-9510-2

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